Ideal Pontic Requirements in Dentistry

Ideal Pontic Requirements

• The pontic should restore the function of the teeth it replaced, ensuring masticatory function efficiency is restored to the proper limit.
• The occlusal surface width may need to be reduced by 20% to reduce torque on retainers and abutments and simplify cleaning, while also considering esthetic, span length, abutment teeth strength, ridge form, and occlusion.

Summary of Pontic Requirements

Esthetic

• The pontic should look like the tooth it replaces.
• Tissue contacts should appear as normal.

Biologic

• The pontic should maintain healthy tissues.
• It should be cleanable.

Mechanical

• The pontic should be strong enough to withstand functional forces.
• It should be rigid and resistant to deformation.
• It should provide normal function.

Designs (Types) of Pontic

A) Pontics with Mucosal Contact

• Saddle Pontic:
  • Overlaps the ridge (largest area of contact).
  • Most natural feeling.
  • Most difficult to clean.
  • Should not be used, but can be used in limited occlusal-gingival space or when patients object to lingual space.
• Ridge Lap Pontic:
  • Like a saddle on the buccal side.
  • Convex on the lingual side.
  • More cleanable than saddle design.
  • Potential for tissue irritation is minimized.
  • Gives the illusion of being a tooth.
  • Combines the best features of saddle and hygienic pontics.
  • Used when the tooth lies in the appearance zone (max and man).
• Modified Ridge Lap Pontic:
  • Contacts tissue only on the most facial surface of the pontic.
  • Most cleanable.
  • Least tissue irritation.
  • Space between the pontic and tissue on the lingual side can be unacceptable to the patient.
  • Used when the tooth lies in the appearance zone (max and man).

B) Pontics without Mucosal Contact

• Conical Pontic (Bullet, Spheroid):
  • Egg-shaped, spheroid, or heart-shaped.
  • Used as a pontic in non-esthetic areas.
  • Convex shape with only one point touching the residual ridge.
  • The easiest design to clean.
  • Used when the occlusal 2/3 of the facial surface lies in the appearance zone, but not the gingival 1/3 (lower incisors, premolars, and molars).
• Ovate Pontic:
  • Most aesthetically appealing.
  • Placed in the convexity on the edentulous ridge.
  • Its convex tissue surface resides in the soft tissue depression, making it appear to be growing out of the tissue.
  • Natural feeling for the patient.
  • Difficulty in cleaning.
  • Potential for tissue irritation.
  • Used for maxillary incisors and premolars.
  • Requires surgical preparation.
• Modified Ovate Pontic:
  • The modification of the ovate pontic involves moving the height of contour at the tissue surface from the center of the base to a more labial position.
  • The modified ovate pontic does not require as much faciolingual thickness to create an emergence profile.
  • Excellent esthetics.
  • Fulfills functional requirements.
  • Greater ease of cleaning compared to the ovate pontic.
  • Its major advantage over the ovate type is that often there is little or no need for surgical augmentation of the ridge.
• Hygienic Pontic (Sanitary, Wash Through):
  • Made entirely from metal.
  • Does not have any contact with the underlying tissue.
  • Primary design for the non-appearance zone in mandibular posterior regions.
  • Most cleanable.
  • Convex shape.
  • No tissue contact.
  • 3 mm space.
  • 3 mm thickness.
  • Patient acceptance is questionable.
  • Disadvantages include entrapment of food particles, which may lead to tongue habits that annoy the patient.
• Modified Hygienic Pontic (Archway Pontic):
  • A modified version of the sanitary pontic.
  • The gingival portion is shaped like an archway between the retainers.
  • This geometry added bulk for strength in the connectors while decreasing the stress concentrated in the pontic and connectors.
  • Made entirely from metal.
  • Does not have any contact with the underlying tissue.
  • Primary design for the non-appearance zone in mandibular posterior regions.
  • Access for cleaning is good.
  • Tissue is less susceptible to proliferation.

Residual Ridge Preservation

• Residual ridge preservation can be achieved using the following techniques:
  • Alveolar Architecture Preservation Technique:
    • Preservation of the alveolar process can be achieved through immediate restorative and periodontal intervention at the time of tooth removal.
    • The procedure involves preparing the abutment teeth prior to extraction and fabricating a provisional FPD indirectly to be ready for immediate insertion.
    • The tissue-side of the pontic should be an ovate form.
  • Conditioning the Extraction Site (Alvelac Pack):
    • Preservation of the alveolar process can be achieved by conditioning the extraction site and providing a matrix for healing.
    • The pre-extraction gingival architecture (or "socket") can be preserved.
    • Alvelac can be used at the time of tooth removal.

For Preexisting Residual Ridge

• Ridge modifications may be necessary:
  • Ridge Reduction:
    • Indications include excessive or irregular soft tissue, inadequate space for the pontic, or poor cleansable areas.
  • Ridge Augmentation:
    • Indicated to treat a defect in the pontic space when there is bone resorption after extraction or a requirement for a long, unaesthetic pontic.
    • Periodontal surgery is done using fibrous, osseous, or synthetic materials to augment the space and treat the defect.
  • Occlusion:
    • The pontic should be designed to restore proper occlusion.